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David Sackett
Steps in the EBM process
Patient
Intervention
Comparison
Outcome
Type of Question
Study Design
Richardson,W.S., Wilson M.
ACP Journal Club 123:A12
Nov-Dec 1995
study design
Formulate the question
Patient Otitis Media, 2 yrs old
Intervention Amoxicillin
Comparison no meds, placebo
Outcome reduce fever, pain, long term
benefit
Question therapy
Study Design randomized, controlled
clinical trial
The well built clinical question is:
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Search on otitis media
the evidence
4. Evaluate the evidence
Validity
Results
Applicability to the patient
Validity issues:
Randomization
Follow-up complete (80% or better)
Blinding (concealed allocation)
Baseline similarities
Groups treated equally
Results of the evidence:
Same diagnosis
Same age groups
General practice population
Study done in Netherlands
5. Return to the patient:
Between 7 and 8 children aged younger
than 2 years have to be treated with an
antibiotic for 1 of them to receive a
symptomatic benefit at 4 days compared
with placebo. However, only a small
percentage (30% to 36%) will be
completely symptom free 11 days after
presentation, regardless of antibiotic
treatment. Since antibiotic treatment is
not completely benign and its benefits are
minimal. Most children between the ages
of 6 months and 2 years need not be
treated with antibiotics.